Bivalirudin
Bivalirudin is a direct thrombin inhibitor anticoagulant used primarily during percutaneous coronary interventions and in patients with or at risk for heparin-induced thrombocytopenia. It works by directly binding to thrombin, preventing the conversion of fibrinogen to fibrin and thereby reducing clot formation. This medication is administered intravenously in hospital settings under close medical supervision.
Bivalirudin is an IV anticoagulant that directly inhibits thrombin to prevent blood clots, commonly used during heart procedures and in patients who cannot receive heparin.
Key facts at a glance
- ATC
- B01AE06
- RxNorm
- 60819
- Generic
- Bivalirudin
- Class
- atc-b01
- Brands
- Angiomax
- Availability
- rx
- Lactation
- unknown
- Routes
- —
- Forms
- injection
- Regions
- US, EU, CN, JP
- Monitoring
- —
This page is for informational purposes only.
Do not use this information to diagnose yourself or to replace a physician's advice. Always consult a qualified healthcare provider before starting, stopping, or changing any medication. If you believe you are experiencing a medical emergency, call your local emergency number immediately.
Dosage and administration
- Usual dose
- 0.75 mg/kg bolus followed by 1.75 mg/kg/hour infusion
- Maximum
- consult physician
- Frequency
- continuous infusion during procedure
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 0.375 mg/kg bolus followed by 0.5 mg/kg/hour infusion
- Maximum
- consult physician
- Frequency
- continuous infusion
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 0.75 mg/kg bolus followed by 1.75 mg/kg/hour infusion
- Maximum
- consult physician
- Frequency
- continuous infusion (adjust based on renal function)
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
Overdose information
Special Populations
6 groupspregnancy
generaluse only if benefits outweigh risks
use only if clearly needed and benefits outweigh potential risks to fetus
close maternal and fetal monitoring
Use with caution and monitor for adverse effects.
lactation
breastfeedingnot recommended
discontinue breastfeeding or avoid use, effects on nursing infant unknown
monitor infant for bleeding or other adverse effects
geriatric
elderlyno specific dose reduction required
use with caution, monitor renal function closely
monitor renal function and bleeding parameters
Use with caution and monitor for adverse effects.
pediatric_age
children adolescentsnot recommended for use
not approved for pediatric patients due to insufficient safety and efficacy data
not applicable - not recommended in this population
Use of this medication in this population requires careful consideration of risks and benefits.
renal_impairment
severe renal impairmentreduce dose to 0.5 mg/kg bolus and 0.25 mg/kg/h infusion for CrCl <30 mL/min
monitor aPTT closely, adjust dose based on renal function, drug is partially eliminated by kidneys
frequent aPTT and renal function monitoring
Use with caution and monitor for adverse effects.
hepatic_impairment
hepatic impairmentno dosage adjustment needed
use with caution, limited data in severe hepatic impairment
standard monitoring of coagulation parameters
Use with caution and monitor for adverse effects.
Statistics and clinical data
FDA approval year
Initial FDA approval for Bivalirudin (Angiomax)
Drug class
Anticoagulant classification
Primary indications
Therapeutic indications for Bivalirudin
Mechanism of action
Pharmacological mechanism of action
Bivalirudin is indicated as an anticoagulant for patients undergoing percutaneous coronary intervention (PCI), including those with acute coronary syndromes. It is also used for anticoagulation in patients with or at risk for heparin-induced thrombocytopenia (HIT) who require parenteral anticoagulation.
Bivalirudin is a synthetic polypeptide that directly and specifically inhibits thrombin by binding to both the catalytic site and the anion-binding exosite of circulating and clot-bound thrombin. By inhibiting thrombin, it prevents fibrin formation, platelet aggregation, and thrombus development.
Bivalirudin is administered intravenously in healthcare settings with appropriate monitoring. Bleeding is the primary risk, and it should be discontinued immediately if bleeding occurs. Renal function should be assessed before use as dosage adjustment may be needed. Unlike heparin, it does not cause HIT and has a shorter half-life allowing for better control of anticoagulation.
Contraindications
Conditions and patient states where this medication should be avoided or used with caution.
Do not use (1)
Known allergy to this medication or its components
Use caution (1)
Consult healthcare provider for benefits vs risks assessment
Official drug label
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This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
This content is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you have about a medical condition, and never disregard professional medical advice or delay seeking it because of something you read here.
If you think you may have a medical emergency, call your local emergency number or go to the nearest emergency department immediately.
Medically reviewed by WellAlly Editorial Team Last reviewed July 26, 2026. · Read our editorial policy